Vasectomy (sterilisation for men)

Vasectomy, or male sterilisation, is a permanent form of contraception. It's a simple, straightforward operation that stops sperm entering semen

By
Dr David Delvin

27/04/2016

A. ChederrosGetty Images

What is vasectomy?

Vasectomy is now one of the most popular forms of family planning in the world. But in Britain there has been a dramatic fall in the number of men who have it done.

Indeed, it has been claimed that the startling reduction in the number of UK vasectomies has been partly responsible for a recent rise in the total of abortions among women aged over 30.

Since 2014, bad publicity about a link between cancer and vasectomy (see below) has caused concern for some men.

Nevertheless, each year large numbers of males decide to have 'the snip'.A word of warning: be careful whom you go to in order to get this operation done. There are (alas) a few doctors who try doing the 'op' just occasionally – with varying degrees of success.

In 2016, there was court case in which a man who had gone to a clinic (to have some scar tissue removed) found that the surgeon had accidentally done a vasectomy on him. Understandably, he was shattered by this experience.

What is vasectomy – and can it cause problems?

It's a permanent form of contraception, but it shouldn't interfere with your sex life because you will still have erections and produce semen when you climax – just as before.

However, a very small number of men do run into trouble with their sex lives after the operation. These are usually males who have psychological problems, such as fear of castration.

Also, there is a very uncommon condition called 'sperm granuloma', which is a painful little lump occurring in the scrotum as a result of leakage of sperm. If it causes pain, it can be removed surgically or in some cases treated with anti-inflammatory pills.

A few men get chronic (long-term) testicular pain after the operation. This is so uncommon that I personally have never seen a case.

However, in some countries – notably the USA – there has recently been a good deal of publicity about this post-vasectomy pain syndrome (PVPS).

Some men have tried to sue their surgeons on the grounds that they were not told that this pain was a possibility. At present, it is still not clear what causes most cases of PVPS, so treatment is a difficult business with an uncertain outcome.

Nevertheless, despite these possible drawbacks vasectomy is now a popular and routine operation throughout the world.

The dramatic fall in numbers of vasectomies in Britain

In 2010, the Marie Stopes organisation estimated that about 13 per cent of British men had 'the snip'.

However by 2016, it has become clear that in the UK, far fewer males are choosing this operation. Figures are thought to have fallen by around 60 per cent over the last decade.

Back at the beginning of the 21st century, the NHS was carrying out nearly 40,000 vasectomies a year. But now this has dropped to about 15,000.

There are no exact figures for all the non-NHS vasectomies that are done in private clinics and doctors' consulting rooms, but these are thought to have fallen too.

Why has this big drop happened? The probable main reason for the fall is that it has become a lot more difficult to get a vasectomy, thanks to funding changes in the NHS.

Also, a lot of couples in their 30s and 40s are opting for efficient 'female' methods of contraception, such as the IUS (intrauterine system), the implant, the patch and the shot.

Since 2014, some men have decided against having the operation because of worries about the possibility of a link between vasectomy and prostate cancer (see next section).

Finally, it seems very likely that some men have decided against vasectomy because they are aware that nowadays relationships often founder, and that it is common for a guy to want to start a second family in his 30s or 40s.

Does vasectomy cause cancer?

Since the 1990s, there have been repeated suggestions that men who have had vasectomies might be more liable to prostate cancer. Some authorities (eg the Mayo Clinic) have been unwilling to accept this.

But the matter now appears to have been settled by a research paper from Harvard, published in the Journal of Clinical Oncology.

The researchers found no connection between 'low grade' (that is, not very dangerous) forms of prostate cancer.

But they discovered that 'high grade' prostatic cancers were to some extent linked with having 'the snip'. There is no need for men to panic about this! The increased risk is not very great.

In fact, the Harvard team reported that:

the incidence of lethal prostate cancer in males who had not had a vasectomy was 16 in 1,000

the incidence in men who had had a vasectomy was 19 per 1,000.

So the increase in risk appears at the moment to be slightly less than 20 per cent.

Furthermore, the American Urological Association
has recently re-calculated the statistics, and at present they say that
there is actually no increased risk associated with vasectomy.

Who is eligible for a vasectomy?

Provided he has thought it over carefully, any adult male can choose to be sterilised by having a vasectomy – though doctors are generally unwilling to do the operation on very young guys, especially those without children.

There are no rules or laws on this point, but few surgeons would consider vasectomising a patient who is under about 28.

Also, if you have had a previous operation on the region of your testicles – including a hernia repair – vasectomy may be more difficult. If you fall into this category, make very sure that the doctor who you choose to do' you is an expert in the field.

You don't have to worry about arranging a hospital admission. Vasectomy is a much simpler procedure than the sterilisation of women and is almost always done on an outpatient basis – in other words, without having to stay in hospital. You can usually go home a couple of hours after the operation.

Can you get a vasectomy on the NHS?

In many parts of the UK vasectomy is still available under the NHS, although in the period 2008 to 2016, getting funding for these operations has become more difficult.

But in many places, you should be able to obtain the procedure free, via your GP, as long as you don't mind waiting a month or two.

However, going privately will almost certainly get you operated on much more quickly.

In remoter country areas of Britain, there is often one GP who does private vasectomies at his or her surgery.

In large cities, there are many clinics that will perform the operation for you, at a cost of anything between £350 and £900. The Marie Stopes chain of charitable clinics currently charges a flat fee of £402 – plus £20 for a sperm test carried out some weeks later. Some of their vasectomies are NHS-funded.

Whom should you contact?

You can talk to your GP, a family planning clinic or any reputable clinic that advertises vasectomy. They should tell you how the sterilisation procedure works and discuss the small risk of unwanted effects.

You should talk over any worries with them – especially about sex. It's then a good idea to have at least a few days to think things over and discuss the procedure with your partner.

I suggest you steer clear of any private clinic that doesn't give you time to think about whether you want to go ahead. A vasectomy is a big step in a man's life, and you shouldn't let yourself be rushed into it.

Does your partner need to know?

It is folly to have a vasectomy without your wife or partner's consent. Taking such a unilateral decision can lead to marital discord.

In addition, it is technically possible that your spouse could sue your surgeon for depriving her of the chance of having further children.

A good clinic will want to discuss alternative types of contraception with you, and to make sure that you and your partner are really happy with the idea of vasectomy and that you understand that you are taking this decision for life.

What happens in a vasectomy?

The actual surgical procedure sounds a bit alarming for most men, but there's usually very little pain and the operation is short.

A few surgeons – mainly in private practice – like to do it while the patient is under a general anaesthetic. (Inevitably, this pushes the cost up quite a lot, because you have to pay for the anaesthetist and all his equipment and drugs.)

But generally, it's all done under local, and you'll be 'in and out' in half an hour.

Did you know?

The tube that carries sperm to semen is called the vas.

Vasectomy means 'cutting out a piece of vas'.

You'll be lying flat on your back. The surgeon will inject a little local anaesthetic into the skin of your scrotum and after that you'll feel no pain.

The surgeon then makes a small cut in your scrotum. Working through this incision, he finds the slim, spaghetti-like tube that carries sperms upwards from your testicle. This tube is called the vas.

He or she then cuts through the vas and seals off the ends.

Next, the cut in the skin is stitched up.

The surgeon does the same thing to the tube on the other side – and that's it.

With modern techniques, the surgeon may not always need to use stitches. If there are any, they'll probably be dissolvable.

There are minor variations in the way that different surgeons perform the operation.

The surgeon may do the whole procedure through one incision instead of two.

The surgeon may use the much advertised 'no-scalpel' technique, also known as 'keyhole vasectomy'. Instead of an incision, the surgeon makes a small 'puncture' in the scrotum, and then inserts a slim instrument through it. Some private clinics now have a lot of experience with this technique.

Whatever the method, it's generally all over within 15 minutes or so.

Will you have any problems afterwards?

Most men are sore and bruised afterwards and this may persist for several weeks. But a few develop bleeding, marked swelling or pain. If any of these things happen, contact a doctor.

Men are often worried about the idea of getting an infection. But in 2013, a team from the British Pregnancy Advisory Service reported that they'd followed up nearly 1200 men and found that only 2.5 per cent of them had had slight skin infections.

In my view, you should wear an athletic support (a 'jock strap') for a week or so after the vasectomy to ease the discomfort. Getting into a warm bath is also very soothing.

Do not attempt any strenuous physical activity or contact sports for at least a month after the operation. Lifting a heavy weight could make a stitch slip and so cause bleeding, but this is uncommon.

Some surgeons advise against flying for a week or so after the operation.

When can you have sex again?

You can have sex as soon as you feel like it after the operation (some men have sex within hours), but you'll need to use an additional contraceptive method for a while.

Yes – you will produce semen. It will look just the same as before and the volume should be the same.

Does sterilisation work immediately?

After the operation, you will still have some sperm left in the tubes that lead to the penis. This means that you must use another contraceptive method for the time being.

There is a new technique in which the surgeon tries to wash the remaining sperms out of your tubing. It's called 'vas irrigation'. So far it has not been widely adopted.

About two to three months after your surgery, you'll need to have a semen test to see if all the sperm have gone. Many surgeons like to make really sure by doing two tests.

Once you have been reassured that no sperm can be seen in your ejaculate – under a microscope – then you can rely on your vasectomy without using any back-up contraception.

But there is still a tiny failure rate, currently quoted as about one in 2,000. Occasionally, men who have had vasectomies find they have sired a child. This is because the tubing has joined up again.

Can vasectomy make you impotent?

Vasectomy does not cause impotence (erectile dysfunction). But it is easy to see that a man who already has psychological problems about sex could feel that his potency is threatened by the operation.

This is why every man who wants to have a vasectomy should have careful preliminary counselling.

If you are troubled by deep castration fears and are terrified by the whole idea of the operation – then don't go ahead.

Similarly, anybody who has difficulties with getting or maintaining an erection is probably not the best candidate for a vasectomy.

Is vasectomy 100 per cent effective against pregnancy?

Vasectomy is not 100 per cent effective. Occasionally, pregnancies do happen.

In Britain, current estimates are that about one in every 2000 vasectomies fails. This generally isn't anybody's fault.

Are there any long-term consequences of vasectomy?

We can't answer this question for certain, because it's only in the last 40 years that vasectomy has become popular – so relatively little research has been done.

As yet, there have been no convincing reports of any serious long-term consequences of having the snip, apart from the possible link with prostate cancer (please see above).

Some researchers have suggested that blood pressure is higher in men who have had vasectomies, at the moment this seems very unlikely.

Will you regret being sterilised?

You need to accept that having a vasectomy means you will probably never be able to have children again.

You may be sure at the moment that you want to go ahead with the operation, but sometimes circumstances change.

These days men often change partners at some point in their lives – and a guy who has had a vasectomy will not be able to father children in a new relationship.

What about reversal?

It is possible to reverse a vasectomy, but this procedure is frequently unsuccessful.

There are very few surgeons who can genuinely claim a success rate of more than 40 per cent.

Some surgeons claim they have much higher success rates, but it usually turns out they mean that they have succeeded in re-joining the tubes or enabling the man to produce some sperm. This isn't the same thing as achieving fatherhood.

One clinic which is currently advertising on the internet claims a success rate of 98 per cent, which is quite surprising.

Reversal is now virtually unobtainable on the NHS. So if you are contemplating having a vasectomy, you should be as sure as you possibly can be that you won't regret the decision. The doctor should talk all this over fully with you before the vasectomy.

At present, having a vasectomy reversal in Britain tends to costs between £1,730 and £5,000 – with no guarantee of success.

Health insurance companies are very unlikely to pay for this.

In general, attempts at reversal of vasectomy are more likely to succeed if they are carried out fairly soon after the sterilisation.

If you've had a vasectomy and later want to have children, there is the option of conceiving a child by artificial retrieval of sperm from your testicle.

This is usually followed by in-vitro fertilisation (IVF) of your partner's egg – in other words, a variant of the test-tube baby technique.

But this is exceedingly expensive, and I'm afraid that often it doesn't work.

Be very sure that you really want to have a vasectomy – and that your partner wants you to have one.

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